RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03484
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060314

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Water Treatment Specialist, medically separated for “mid thoracic and low back pain [LBP]” and “bilateral hand forearm pain” with subsumed “left knee pain” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  “Please consider all conditions.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is based upon a review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB – 20060123	VARD - 20060623	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mid Thoracic  & LBP	5237	10%	Thoracolumbar Disability	5237	40%	20060426	
Bilateral Hand Forearm Pain	5099-5003	10%	RUE, Ulnar Nerve Neuralgia	8716	10%		
			LUE, Ulnar Nerve Neuralgia	8716	10%		
Chronic Left Knee Pain			Chondromalacia…Left Knee	5260	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

Analysis Summary. 

Mid Thoracic and Low Back Pain.  The record shows that the CI was activated on 8 September 2004 and deployed on 5 November 2004.  He was placed on quarters for LBP on 6 December 2004 for 48 hours.  On 9 December 2004, he was seen in follow-up and reported a 1 week history of pain which developed insidiously after he had “the flu.”  He thought that it might have been caused by coughing too much.  On examination, motion was reduced and his motor function impaired by pain.  He was treated with medications and duty limitations with rapid improvement over the next few days and apparently returned to full duty.  A developmental counseling form dated 2 January 2005 recorded the CI was working as a forklift operator, warehouse storage clerk, and gate guard.  “Your actions in all these areas have shown great professionalism and integrity.”  The only “downfall” cited was loss of physical control of his M-16.  On 22 January 2005, the CI was evaluated for a 1 week history of bilateral forearm pain and a cold sensation.  He had been participating in construction work with significant torque movement (screwdrivers, etc.) for the previous month.  He was thought to have a bilateral carpal tunnel syndrome (CTS; symptoms from compression of the median nerve in the wrist) and treated with medications, splinting, and duty restrictions.  Another developmental counseling form dated 31 January 2005 commended the CI for extending his enlistment for 6 years and noted he was limited in his primary duties by problems with his wrists.  Despite treatment, his symptoms persisted, albeit improved, and the CI was evacuated to Germany from the theater on 22 March 2005 for the bilateral median nerve condition.  He was evaluated in orthopedics and thought to have a bilateral CTS condition.  There, he reported a 3-month history of bilateral wrist and hand pain and numbness.  He also reported some LBP from a basketball injury.  He reported that he owned a construction company for his civilian occupation.  X-rays were normal.  He was referred to physical medicine for electro-diagnostic studies (EDX).  On examination, there was no atrophy and the motor function was normal other than possible weakness in spreading the fingers on the left.  The EDX study was unremarkable (normal).  An MRI of the cervical spine showed mild degenerative joint disease (DJD).  Neural compromise was not documented nor was degenerative disc disease (DDD).  He was then evaluated in neurosurgery on 30 March 2005.  The CI endorsed LBP with numbness in the “butt” and pain in the legs.  He also reported that he was in a truck which was hit by an IED (improvised explosive device) in November 2004.  This is the first this is found in the records in evidence.  He was noted to have weakness of the upper and lower extremities, but a normal gait and full range of motion (ROM) of all four extremities.  He was thought to have a bilateral ulnar neuropathy (cubital tunnel syndrome, a different nerve that the median nerve) and return to his home duty station for surgery was recommended.  He was evaluated in occupational therapy (OT) and orthopedics in April 2004 and thought to have symptoms consistent with cubital tunnel syndrome although the EDX study had been normal.  The CI was evaluated in primary care on 24 May 2005 and reported that he had been wounded by an IED and had persistent LBP which radiated into both lower extremities (BLE).  An MRI of the lumbar spine on 7 June 2005 showed multi-level DDD with nerve root or cord compromise and minimal multi-level DJD.  The CI was seen in follow-up in orthopedics for the bilateral cubital tunnel syndrome and was noted to have persistent symptoms, but no atrophy.  A previous injection had provided good relief of his pain for 1 week.  A post-deployment evaluation was accomplished on 15 June 2005.  He reported ongoing LBP secondary to an IED explosion while in a vehicle.  He denied a head injury, concussion, or loss of consciousness (LOC).  On examination, he was noted to have reduced ROM, but a normal gait and neurological examination.  He was given the first of 3 epidural steroid injections with improvement in his symptoms.  The CI was evaluated in neurology on 27 July 2005 for the bilateral ulnar neuropathy.  He reported that he was driving a truck which was struck by a roadside bomb and hit his elbows with his knees and driver’s seat.  He noted pain in the hands and elbows since along with numbness of the little fingers.  The neurological examination was normal other than decreased sensation to the little fingers.  The gait was normal.  Three days later in primary care, he was noted to have a normal gait, neurological examination (of the lower extremities) and ROM of the back.  Repeat EDX studies of the right upper extremity (RUE) were normal, but the relatively small of the right ulnar palmar amplitude compared to the median palmar response was thought to possible represent an ulnar sensory deficit from his injury.  On 5 August 2005, the CI was again seen in primary care and noted to have limitation in the back ROM to 70% of normal with a normal neurological examination.  On 9 September 2005, the CI was limping due to pain in the left knee from an old injury.  He reported that he had a recent increase in pain and that he had been shot by a .22 rifle 22 years earlier (pre-service).  He also reported surgery of the left knee 1 year previously for an injury to the anterior cruciate ligament (ACL).  On examination on 20 September 2005, the knee was tender, but stable.  He was profiled for shoes of comfort and reported a reduction in pain with this.  The CI was seen in follow-up in neurology on 5 October 2005 for the bilateral ulnar neuropathy.  He reported pain and tingling in the ulnar distribution since his truck came to a road bump while he was deployed.  He was thought to have a bilateral ulnar sensory deficit which was attributed to his accident.  An MRI of the left knee on 21 November 2005 was consistent with the old bullet injury and degeneration of the kneecap.  The MEB forwarded hand and forearm pain, mid thoracic pain, low back pain, and left knee pain for PEB adjudication.

According to the MEB narrative summary (NARSUM) dated 3 November 20005 and the MEB examination dated 17 October 2005, the CI’s back condition began after an IED blast in October 2004 when injured while deployed in combat.  As documented above, this history is not consistent with records from the initial presentation.  The Board also noted that the CI was not awarded a Purple Heart although 10A. and 10C. were noted on the PEB.  The MEB NARSUM examination, 4 months prior to separation, recorded mid-back pain and LBP which radiated to both calves and buttocks.  The CI reported that the IED explosion jerked the vehicle to the side causing torque of his arms and upper body and lower back.  He denied incontinence. The physical exam showed hypersensitivity and tenderness over the lower spine.  The motor and reflex examinations were normal as was the toe and heel walk.  The ROM was reduced and the examiner stated “flexion is seemingly limited by muscle spasm at about 20 degrees.”  Spasm was not otherwise documented though.  Three weeks later, the ROM in physical therapy was significantly improved (as charted below) despite noting that 2/5 signs of non-organic pain were present.  At the VA Compensation and Pension (C&P) examinations performed on 26 April 2006, 6 weeks after separation, the CI reported pain that he was injured in October 2004 when an IED exploded near the truck he was driving.  His upper extremities and upper torso were torqued leading to pain in the mid and lower back which was treated in Germany and at his home station.  The Board that this is not consistent with contemporaneous records.  He reported the use of a cane when his LBP flared.  He could walk a block before his pain increased.  He denied incapacitation.  On examination, his gait was normal, but he appeared to be in discomfort and moved deliberately.  He shifted his position frequently when sitting.  Tenderness and guarding were present, but spasm was not documented.  The ROM was limited to 30 degrees flexion (90 normal) and 25 degrees left lateral flexion (30 is normal), but otherwise normal.  Sensation was intact.  Motor function was 4/5 in all 4 extremities.  The reflexes in the lower extremities was symmetric and 1+.  Signs of non-organic pain were absent.  X-rays of the thoracic pain were normal and those of the lumbar spine suggested DDD at L5-S1.  One week later, the CI had a mental health C&P examination for PTSD (post-traumatic stress disorder).  He reported that the truck he was driving was hit by an IED and the steering wheel was ripped off and hit him; he sustained life-threatening injuries.  He was unable to lift anything, but was trying to work as a contractor again.  

No further records which address the back are in evidence until a poly-trauma note dated 30 April 2008, over 2 years after separation.  It noted that the CI was driving a fuel truck on 28 October 2004 when an IED exploded in front of the vehicle.  The windshield shattered and the truck was hit by shrapnel.  The gunner in the turret above him fell into his arms.  He then swerved the truck, bending his back and injuring both elbows.  He reported confusion (denied on the in service post-deployment and pre-separation histories), but denied LOC.  He endorsed ongoing LBP.  On examination, the neurological examination was normal other than decreased sensation in the ulnar distribution bilaterally.  The ROM of the neck, extremities, and back was normal.  He had a painful gait and was unable to stand on his toes due to calf pain on the right.  The next day the CI had a follow-up PTSD evaluation and reported that he drove through an underpass.  The explosion jerked his arms to the side and some tendons were torn.  Two weeks later, a spine C&P recorded that the CI was in an explosion on 28 November 2004 with injuries to his spine that lead to hospitalization for 1 month.  He was then transferred back to his home station for 1 year of rehabilitation.  Flexion was to 70 degrees and extension to 120 (probably a typo for 20 degrees).  Side bending and rotation were to 25 degrees bilaterally.  Atrophy and spasm were absent.  The ROM examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Thoracolumbar ROM
(Degrees)	PCC ~8 Mos. Pre-Sep	NARSUM ~4 Mos. Pre-Sep	PT ~4 Mos. Pre-Sep	VA ~1 Mo. Post-Sep	VA ~ 26Mo. Post-Sep	
Flexion (90 Normal)	~70% (65)	“Seemingly limited” to about 20 degrees	65 (64, 64, 65)	30 (30)	70	
Combined (240)	---	---	205	180	190	
Comments	Tenderness	Tenderness.  Possible spasm.  No atrophy; Normal gait.  	2/5 signs of non-organic pain present	Painful motion, Tenderness, Guarding, Normal Gait, , No Incapacitation	Nml neuro; no atrophy; no spasm.  	
§4.71a Rating	10% (PEB 10%)	40% (PEB 10%)	10%	40%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the mid thoracic and low back pain 10% coded 5237 (thoracolumbar strain), citing limitation of flexion to 69 degrees (a passive measurement of flexion recorded at the PT examination on 26 November 2005.  The VA also used the 5237 code, but rated the back condition 40%, based on the VA C&P examination 1 month after separation, citing limitation of flexion to 30 degrees.  The Board considered the evidence.  It noted that the VA C&P examination supports a 40% rating.  However, there was no recorded spasm or other indication of why the flexion was so limited compared to other examinations and the essentially normal ROM otherwise documented on this examination.  The NARSUM measurements show flexion of 20 degrees, but caveated with the comment “seemingly limited.”  The Board noted considerable variability in the ROM on different examinations without explanation for the limitation when present.  It also noted that the ROM measured is, in part, dependent upon the effort of the individual being examined.  In addition, history of the etiology of pain was inconsistent from one examination to another.  The objective findings show a typically normal neurological examination and gait.  Imaging studies show minimal disease which the medical officer observed is not unusual for someone in their late 30’s.  The Board noted that the two examinations remote from separation showed normal or near normal ROM as well.  Incapacitation did not support a higher rating that the 10% adjudicated by the PEB.  The neurological examination was typically normal; when loss was present, it was not consistent from one examination to the next.  An additional rating for a radiculopathy is not supported.  The Board considered the totality of evidence and determined that the 10% rating adjudicated by the PEB best represented the impairment present at separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the mid-thoracic and back pain condition.  

Bilateral Hand Forearm Pain.  The PEB rated the bilateral hand forearm pain as a single unfitting condition coded analogously to 5003 and rated 10% with application of the USAPDA pain policy.  The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications or implied adjudication that each condition was separately unfitting.  The Board also noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.  The Board’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the Board considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the Board recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  As noted above, the right dominant CI was initially evaluated for what was thought to be a bilateral carpal tunnel syndrome (in the wrists) and later thought to have cubital tunnel syndrome (a problem near the elbows).  Initially, this was noted in the context of increased use of the upper extremities in construction, but later linked to an IED blast by the CI in which both elbows were injured.  The Board again observed that this blast was not recorded in the medical records in evidence while in theater and first noted after evaluation to Germany.  The initial EDX studies were normal; the second set was thought to also be normal but to possibly show a right sided sensory deficit of the ulnar nerve.  An orthopedic examination on 10 June 2005 noted full ROM without atrophy.  A neurology evaluation on 27 June 2005 showed normal strength and reflexes.  There was a slight decrease to light touch bilaterally of the little fingers.  The EDX study on 2 August 2005 was noted to be normal, but also “could represent ulnar sensory neuropathy secondary to his injury.  An OT evaluation on 30 August 2005 noted that he had normal ROM and motor function.  In neurology on 5 October 2005, he was free of tingling, but that the elbow was hypersensitive to touch.  This was seen on the examination along with decreased sensation of the little finger(s).  He was advised to continue to use the elbow protector.  Continued improvement was expected.  The MEB NARSUM examination showed normal strength and ROM although his pain was aggravated by testing the motor function on the left.  The strength for the right elbow was therefore not tested.  The sensory examination was not recorded.  At the VA General C&P) examination 6 weeks after separation, the strength for the upper extremities was recorded as 3/4.  Under the spine examination, done by the same examiner, it was noted to be 4/4 with intact sensation.  The reflexes in the upper extremities were not present on this examination.  On the C&P examination for the peripheral nerves, also done by the same examiner the same day, the CI reported pain, weakness, and sensory loss of the upper extremities with poor grip and increased pain with any twisting or flexing motion.  Sensation was noted to be reduced in a C8 dermatome (ring and little fingers) but without atrophy.  An immediate reflex response was noted when the CI placed weight on either elbow; this was thought to suggest an ulnar nerve neuralgia.  The ROM was normal and the grip strength was greater than age adjusted mean values.  The VA poly-trauma examination 26 months after separation recorded normal sensation of both upper extremities as well as a normal motor and reflex examination.  Tapping the ulnar nerve (Tinnels test) was positive consistent with residual sensitivity and consistent with a subjective report of decreased sensitivity in the ulnar distribution bilaterally.  

The Board directed attention to its rating recommendation based on the above evidence.  The MEB forwarded hand and forearm pain without a specific diagnosis.  The PEB rated the CI at 10% for bilateral hand and forearm pain “related to a spinal jolt sustained in an IED explosion in Iraq, Oct 04”, coded 5099-5003 (analogous to degenerative arthritis) citing moderate and frequent pain (language of the US Army Physical Disability Agency [USAPDA] pain policy [AR 635-40]).  The VA rated each upper extremity at 10%, coded 8716 (neuralgia of the ulnar nerve at the mild level), based on the diagnosis of bilateral ulnar nerve neuralgia made on the C&P examination 6 weeks after separation.  The Board considered the evidence.  The Board noted that the PEB cited an IED explosion in Oct 04 as causative of the bilateral hand and forearm pain; however, review of the DD 214 shows that the CI did not deploy until 5 November 2004.  As noted above, this was not documented on the counseling forms in January 2005 and not recorded in the medical records until after evacuation from the theater of operations.  The CI reported persistent loss of sensation and pain.  On examination, the sensory loss was somewhat inconsistent, but typically showed diminished (but present) sensation of the little fingers bilaterally while the motor function was intact.  Atrophy was not recorded.  The EDX studies were initially normal and later showed a suggestion of a sensory ulnar neuropathy on the right (but not the left).  The final neurology note documented hyperesthesia (increased sensitivity to touch) of the elbows and decreased sensation of the little finger with bilateral ulnar neuropathy.  He reported the paresthesias had resolved.  The C&P examinations were internally inconsistent with each other noting normal and diminished sensation; these were done the same day by the same examiner.  The 8716 code supports a maximum of a 20% rating, no more than the rating for a moderate incomplete paralysis.  The EDX studies on the left were consistently normal and the examination variable.  The right side did show a variation consistent with a sensory loss of the ulnar nerve on the second study.  The evidence supports a 10% for a mild neuralgia of the right ulnar nerve and a 0% rating for a minimal neuralgia of the left ulnar nerve.  This provides no advantage to the CI over the PEB adjudication though.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral hand and forearm pain condition.  

Chronic Left Knee Pain.  The PEB did not separately adjudicate the left knee.  Rather, it noted that it was included in the pain rating (for the hand and forearm condition) and could not be separately rated.  It was implied that it was separately unfitting though.  According to the records, the CI’s left knee condition began in as early as 1992, prior to accession when he suffered a gunshot wound to that knee.  The CI then underwent surgery of that knee in 2004 prior to activation.  He was not evaluated for knee pain until September 2005 while on medical hold and in the MEB process.  He reported several months of pain aggravated the past month by activity, but resolved with the wear of shoes of comfort.  Tenderness was present, but the knees were stable.  The Board noted for the record that the PEB did not comment on the EPTS (existed prior to service) nature of the knee condition nor did it cite DoDI 1332.38 E.P3.5. (Presumption of fitness; implied since the CI was in the MEB process before the knee was symptomatic without documented further aggravation of the EPTS injuries).  As the PEB did not address these, they are outside the Scope of the Board.  Radiographic studies (MRI) performed November 2005 showed extensive damage to the cartilage under the knee cap (grade 3-4 chondromalacia) and a possible accumulation of calcium or, less likely, leftover metallic fragments from the gunshot wound.  There was no further surgical indication.  Despite conservative treatment, the left knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty, so the CI was referred for a MEB.  The MEB forwarded “left knee pain” for PEB adjudication.  The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below. 

Left Knee ROM
(Degrees)	NARSUM ~4 Mos. Pre-Sep	PT ~2 Mos. Pre-Sep	VA C&P ~1 Mo. Post-Sep	
Flexion (140 Normal)	“Full”	140	120	
Extension (0 Normal)		0	0	
Comment	Crepitus.  Painful motion was not recorded.	ROM exceeds VA normal values.  Pain on the left with passive ROM to 150 degrees	Normal Gait.  Stable knee.  Painful motion.  	
§4.71a Rating	0%	0%	10%	

The CI was measured for MEB ROM at a physical therapy appointment on 3 January 2006, 2 months prior to separation.  The examination results are depicted in the chart above.  At the MEB examination (recorded on DD Form 2807 and 2808) dated 17 October 2005, 5 months prior to separation, the examiner noted tenderness and no ligamentous laxity.  The MEB NARSUM on 3 November 2005 noted that the knee pain generally occurred after negotiating stairs.  The CI indicated he could walk on level ground for indefinite lengths without difficulty or pain.  Examination revealed stable ligaments and no swelling or tenderness.  Other examination results are reflected in the chart above.  At the VA Compensation and Pension (C&P) examination on 26 April 2006, performed 1 month after separation, the CI reported continuous left knee pain and knee stiffness in the morning after prolonged activity.  He noted instability on uneven or inclined terrain and fatigability with prolonged walking or bending.  No swelling or locking was reported by the CI.  On examination, testing for ligament or cartilage involvement was negative.  Radiographic study (X-ray) revealed metallic density in the images, indicative of the gunshot wound suffered prior to service, with no radiographic evidence of degenerative joint disease.  The gait was normal.  The ROM was limited and painful as charted above.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB included the left knee condition in conjunction with bilateral hand and forearm pain, coded 5099-5003 (analogous to degenerative arthritis).  The VA rated the left knee condition 10%, coded 5260 (limitation of leg flexion), citing painful motion.  The Board noted that while the VA examination showed limited and painful motion, the previous examinations did not show either.  The CI reported that his symptoms resolved with the wear of a shoe of comfort and had a normal gait at the time of the VA examination.  The CI did not show limitation in motion, instability, or cartilage damage to support a rating under the codes specific for the knee.  Painful motion was present on one examination, but not others, and this examination noted a normal gait.  The use of the code 5003 requires X-ray evidence of involvement of 2 or more major joints or minor joint groups.  This was not in evidence in the records available for review.  While there was DJD of the lumbar spine, it was rated separately and cannot be used to support a second rating without violation of VASRD §4.14 (avoidance of pyramiding).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left knee pain condition.  

BOARD FINDINGS:  In the matter of the mid-thoracic and low back pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the bilateral hand (and) forearm pain condition and IAW VASRD §4.71a and §4.124a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the chronic left knee pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140628, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017496 (PD201403484)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA